As a woman and a mother I understand the changes which occur in our bodies at certain times in a women's life. Menstrual cycles, pregnancy, nursing and the challenges related to trying to return to a prepregnancy state after having a child. I was fortunate monthly cycles did not affect me much physically or emotionally.However, many women are affected with irregular menses, mood swings, painful and heavy menstruation and bloating. Some even suffer with severe unexplained pelvic pain. You see your family physician or gynecologist and 9/10 are often told it is nothing. Your physician may order a pelvic ultrasound or do a pelvic exam; only for the tests to come back negative. But you still have pain?Pelvic varicosities can be difficult to diagnose unless a good solid ultrasound, CT or MRI with contrast is ordered. You can definitely diagnose with a dye study of the pelvis where the veins are outlined. This is called a pelvic venogram.Pelvic congestion syndrome is real. It is a condition of varicose veins in the pelvis for women and men. Sometimes pelvic pain may be related to ovarian cysts or fibroids in the uterus. Another condition known as adenomyosis is a condition in which the lining of the uterus located in the endometrium transplants itself in the muscle of the uterus called the myometrium. This condition can cause heavy menstrual bleeding and pain.I will name some of the common disorders related to pelvic pain and describe how to diagnose and treat.

Pelvic congestion syndrome can be diagnosed with a dedicated pelvic ultrasound or CT or MRI with contrast. Once the diagnose is confirmed by the radiologist; an interventional radiologist can perform a pelvic venogram by placing a catheter in the vein in the groin and injecting dye to outline the ovarian or testicular vein to see if there are pelvic varicosities. We place the catheter directly in the vein feeding the varicose veins and inject particles, glue or coils to close off the incompetent veins thus treating the varicose veins. This process can take 45 minutes to an hour and you may leave the outpatient center or hospital that day. The alternative is surgery with removing the dysfunctional veins which leads to a scar and an overnight or several day hospital stay.

Fibroid uterus- Fibroids are benign tumors, non cancerous cells with abnormal growth. The mass effect or pressure on either the lining of the uterus (endometrium), myometrium (muscle layer) or serosal layer (outer portion of the uterus) may cause heavy bleeding, pain and the mass effect on the serosal layer or outer aspect of the uterus. If the fibroid is located in the serosal layer they may cause pressure on the bowel or bladder. This is usually caused by an imbalance of excessive estrogen over progesterone. This condition is often diagnosed with a pelvic ultrasound, or MRI. How can we treat? Conventionally if treated by a gynecologist the choice is medical therapy, myomectomy or hysterectomy. Some often advise if you can wait until menopause the fibroids will go away because you no longer have excessive estrogen. We as interventional radiologists can treat by a procedure called uterine fibroid or uterine artery embolization. We place a catheter in the artery in the groin which leads to the uterine artery. We inject dye to outline the uterine artery and sometimes the ovarian artery. The fibroids are fed by the vascular supply. We place tiny particles under TV (x-ray)guidance and close off the blood supply thus slowly killing the fibroids. This does not kill the uterus as the uterus has an awesome alternative blood supply.I usually send women home that day instead of keeping overnight as I believe we heal better in our own homes. The biggest hurdle you will have to consider is keeping your pain under control which we can do with a pain medication prescription. The pain subsides considerably after 1-2 days. The alternative is a scar and layed up for at least a week with no driving for six weeks. Treatment: Uterine Fibroid Embolization, high-intensity focused ultrasound guided by MRI to treat fibroids, hysterectomy, myomectomy, hormonal therapy or wait until menopause.

Adenomyosis- the lining of the uterus travels to the muscle of the uterus. This condition may cause heavy bleeding and pain. We diagnose this condition through a MRI of the pelvis with contrast. We can treat the same way as we treat fibroids with uterine artery embolization.​Infertility- This can be very devastating to women who yearn to have a child. There are many causes for infertility. The one cause we as IR docs can treat is opening up blocked fallopian tubes. The fallopian tubes are tubes which transport the egg from the ovary to the uterus. Fertilization is when the sperm permeates the egg. The fertilized egg then needs a home to implant for oxygen and nutrients in order to grow and multiply. The home is called the uterus. Fallopian tubes can be blocked due to scar tissue. Diagnosing blocked fallopian tubes can be done by a diagnostic radiologist by placing a temporary device in the cervix and injecting dye to outline the uterus and fallopian tubes. This test is called a hysterosalpinogram. We can treat by using the same mechanism of placing a speculum in the vagina, placing a temporary device in the cervix, injecting dye to outline the uterus and potentially blocked fallopian tube. We then advance a thin wire the size of angel hair pasta, advance the wire with a catheter and open the tube. We can use a small balloon to open the tube. Inject contrast to confirm we have opened the tube successfully and place you on anti inflammatory medications. The procedure is called Recanalization of the fallopian tubes or reopening of the fallopian tubes.

The majority of these conditions are associated with an abnormal ratio of the hormone estrogen to progesterone. Estrogen is a building hormone so therefore if we make too much in the adipose tissue or too much from the ovaries it causes excess thus producing ovarian cysts, fibroids, abnormal growth of the lining of the uterus (endometrium). If the endometrium migrates in to the muscle layer of the uterus (adenomyosis) or outside the uterus (endometriosis) this condition causes severe pain and bleeding, infertility and depression. As an aside a simple piece of advice:Simply put a lifestyle of organic fruits and vegetables (rainbow-colored), hormone -antibiotic free poultry, eggs and red meat. Wild fish not farm raised fish consumption will help cleanse and purify the body.Assistance in removing excessive estrogen-eat your broccoli or supplement with broccoli seed extract such as oncoplex helps to break down estrogen in the liver, calcium d-glucarate helps mobilize excess estrogen out of the intestines. Don't eat foods sprayed with pesticides or drink from plastic containing PCB's.

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